Delayed hemolytic transfusion reaction

A delayed hemolytic transfusion reaction (DHTR) is a type of transfusion reaction.[1][2][3] According to the Centers for Disease Control's (CDC) National Healthcare Safety Network's (NHSN) Hemovigilance Module[4], it is defined as:

Delayed hemolytic transfusion reaction
SpecialtyHemoglobin

Mechanism

If a person without a Kidd blood antigen (for example a Jka-Jkb+ patient) receives a Kidd antigen (Jka-antigen for example) in a red blood cell transfusion and forms an alloantibody (anti-Jka); upon subsequent transfusion with Jka-antigen positive red blood cells, the patient may have a delayed hemolytic transfusion reaction as their anti-Jka antibody hemolyzes the transfused Jka-antigen positive red blood cells. Other common blood groups with this reaction are Duffy, Rhesus and Kell.[5]

Diagnosis


  • Positive direct antiglobulin test (DAT) for antibodies developed between 24 hours and 28 days after cessation of transfusion
  • Positive elution test with alloantibodies present on the transfused red blood cells OR newly identified red blood cell alloantibodies in recipient serum.
    Antibody elution is the process of removing antibodies from the surface of red blood cells. Techniques include using heat, ultrasound, acids or organic solvents. No single method is best in all situations.[6] In an elution test, the eluted antibodies are subsequently tested against a panel of reagent red blood cells of known phenotype.[7]
  • Inadequate rise of post-transfusion hemoglobin level OR rapid fall in hemoglobin level back to pre-transfusion levels OR otherwise unexplained appearance of spherocytes.


PROBABLE DIAGNOSIS

  • Newly identified red blood cell alloantibody demonstrated between 24 hours and 28 days after cessation of transfusion BUT incomplete laboratory evidence to meet definitive case definition criteria.

Epidemiology

Delayed blood transfusion reaction occurs more frequently (1 in 20,569 blood components transfused in the USA in 2011) when compared to acute haemolytic transfusion reaction.[8]

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References
  1. Noizat-Pirenne F, Bachir D, Chadebech P, et al. (December 2007). "Rituximab for prevention of delayed hemolytic transfusion reaction in sickle cell disease". Haematologica. 92 (12): e132–5. doi:10.3324/haematol.12074. PMID 18055978.
  2. Talano JA, Hillery CA, Gottschall JL, Baylerian DM, Scott JP (June 2003). "Delayed hemolytic transfusion reaction/hyperhemolysis syndrome in children with sickle cell disease". Pediatrics. 111 (6 Pt 1): e661–5. doi:10.1542/peds.111.6.e661. PMID 12777582.
  3. Elenga N, Mialou V, Kebaïli K, Galambrun C, Bertrand Y, Pondarre C (December 2008). "Severe neurologic complication after delayed hemolytic transfusion reaction in 2 children with sickle cell anemia: significant diagnosis and therapeutic challenges". J. Pediatr. Hematol. Oncol. 30 (12): 928–30. doi:10.1097/MPH.0b013e31818c9172. PMID 19131783.
  4. "NHSH Biovigilance Component: Hemovigilance Module Surveiilance Protocol v2.5.2". Retrieved May 1, 2018.
  5. Vassiliki Kazakou, MD; Alexandra Kousoulakou, MD; Euthemia Melissari, MD (2007). "Delayed hemolytic transfusion reaction by a Kidd antibody after heart surgery: Case report and review of the literature". The Journal of Thoracic and Cardiovascular Surgery. 133 (5): 1364–5. doi:10.1016/j.jtcvs.2006.11.022. PMID 17467459. Archived from the original on 2013-04-14.
  6. George H. Roberts (2006). "Elution Techniques in Blood Bank" (PDF). American Medical Technologists (AMT).
  7. Brian Nagao, Shan Yuan, Qun Lu (2011). "Drug-induced Immune Hemolytic Anemia and Thrombocytopenia" (PDF). Transfusion Medicine. 54 (4).CS1 maint: multiple names: authors list (link)
  8. "The 2011 National Blood Collection and Utilization Survey Report" (PDF). Department of Health and Human Services. Retrieved 21 January 2016.
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